MEDICARE: DR. PAMELA A MOORE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	18697	TX

General Provider Information

NPI Number	:	1851390900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA A MOORE DDS

Provider Business Mailing Address
First Line	:	1524 INDEPENDENCE PKWY
Second Line	:	SUITE A1/B
City	:	PLANO
State	:	TX
Zip	:	75075-6406
Country	:	US
Telephone Number	:	972-398-1996
Fax Number	:	972-398-8475

Provider Business Practice Location Address
First Line	:	1524 INDEPENDENCE PKWY
Second Line	:	SUITE A1/B
City	:	PLANO
State	:	TX
Zip	:	75075-6406
Country	:	US
Telephone Number	:	972-398-1996
Fax Number	:	972-398-8475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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